Healthcare Provider Details

I. General information

NPI: 1912832320
Provider Name (Legal Business Name): CLAYTON LEE STAPERT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21685 WISE RD
GOBLES MI
49055-9673
US

IV. Provider business mailing address

21685 WISE RD
GOBLES MI
49055-9673
US

V. Phone/Fax

Practice location:
  • Phone: 269-552-8284
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201014680
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: